It has long been established that being black in America is hazardous to your health. For one thing, African Americans are at higher risk of heart disease — the nation’s No. 1 killer — than their white neighbors.

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Is racism partly to blame? A new study provides evidence that points in that direction.

It finds that, while there is a nationwide racial gap in the rate of circulatory disease, it is more pronounced in counties where white residents are more overtly racist.

“To our knowledge, this is the first research to show that racial bias from a dominant group — whites — predicts negative health outcomes more strongly” for a minority group than the dominant group, writes a research team led by psychologist Jordan Leitner of the University of California–Berkeley.

“These results support previous findings that blacks’ subjective perceptions of racism are linked to their own health.”

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The researchers compared county-level death rates from circulatory diseases, compiled by the Centers for Disease Control, to data on racial bias compiled on the Project Implicit website.

“The black-white disparity in access to affordable health care was more pronounced in counties where whites harbored more explicit racial bias.”

The site features tests people can take to measure their unconscious levels of bias. It also asks visitors to rate their feelings about both white and black Americans on a scale of zero (very cold) to 10 (very warm).

Since people visit the site voluntarily, the test-takers are not necessarily representative of their county as a whole. That said, the number of visitors between 2003 and 2013 was quite large: The researchers analyzed nearly 1.4 million responses of white Americans living in 1,836 counties.

They then controlled for a variety of factors that could influence heart disease rates, including age, education, and income. Even after taking all of these into account, a clear pattern emerged.

In counties where whites expressed higher levels of explicit anti-black bias, the rate of circulatory-disease-related deaths was higher overall. But the gap between black and white death rates was also above the national average.

While the results do not suggest cause and effect, they “support the notion of a direct relationship between whites’ racial bias and black-white health disparities,” the researchers write in the journal Psychological Science.

Leitner and his colleagues point to a number of “causal pathways” that could account for these results, including “structural (discrimination in health care), interpersonal (hostile interactions), emotional (stress), and behavioral (maladaptive coping),” such as overeating or excessive drinking to numb the pain of rejection.

Any or all of these could “catalyze biological systems that increase disease risk,” they note.

Indeed, in a second study, they found “the black-white disparity in access to affordable health care was more pronounced in counties where whites harbored more explicit racial bias.” In places where African Americans find it harder to see a doctor, health problems can go untreated until it is too late.

Also worth noting: The finding that whites, too, suffer higher-than-average levels of heart-disease-related deaths in counties that are relatively rife with racism. “One explanation,” the researchers write, “is that highly biased communities have decreased social capital (that is, trust and bonding between community members), which in turn predicts negative health outcomes.”

So racism may be a health hazard — both for its victims, and for racists themselves.

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